{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:53:20Z","timestamp":1787756000003,"version":"build-2784847793"},"reference-count":42,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Intraperitoneal onlay mesh (IPOM) reduces ventral\/incisional hernia recurrence but raises concern for adhesions and infection, particularly when the operative field is not strictly clean. We aimed to determine how contamination severity modulates the peritoneal response to intraperitoneal polypropylene mesh. Materials and Methods: In a prospective, randomized, blinded rat study, 60 male Wistar rats were allocated to three groups (n = 20\/group) and evaluated at postoperative day (POD) 4 and POD 8 (n = 10\/timepoint): A, clean mesh placement; B, small-bowel resection with end-to-end anastomosis without spillage (\u201cpotentially septic\u201d); and C, mesh placement followed by intraperitoneal inoculation with Escherichia coli and Staphylococcus aureus (\u201ccontrolled contamination\u201d). The primary outcome was adhesion severity (Van der Ham scale, 0\u20133). Secondary outcomes included semi-quantitative histological scores (0\u20134) for neutrophil infiltration, fibroblast proliferation, neoangiogenesis, and collagen deposition. Prespecified non-parametric analyses were applied. Results: All animals completed follow-up; no pre-sacrifice deaths occurred. Adhesion severity showed no statistically significant differences between Groups A and B at either timepoint (mean POD4: 0.3 vs. 0.6; POD8: 0.4 vs. 0.8; p &gt; 0.05). In contrast, Group C demonstrated markedly higher adhesion scores (mean POD4: 2.3; POD8: 2.4; both p &lt; 0.001 vs. Groups A and B), with a substantially greater proportion of grade 2\u20133 adhesions. Histological parameters paralleled these findings: at both POD4 and POD8, Group C showed significantly higher neutrophil, fibroblast, neoangiogenesis, and collagen scores compared with Groups A and B (all p &lt; 0.001). No statistically significant within-group temporal differences were observed between POD4 and POD8. Conclusions: In this experimental model, intraperitoneal polypropylene mesh demonstrated similar early biological response patterns in clean and controlled contamination settings, whereas established intra-abdominal sepsis was associated with a marked escalation of inflammation, fibroproliferation, and adhesion formation. These findings suggest that selective use of synthetic intraperitoneal mesh may be considered when contamination is controlled, while caution is warranted in frankly septic environments.<\/jats:p>","DOI":"10.3390\/medicina62050803","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T12:00:32Z","timestamp":1776859232000},"page":"803","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraperitoneal Polypropylene Mesh in Clean, Potentially Septic, and Controlled Contamination Fields: An Experimental Rat Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Apostolos","family":"Makrantonakis","sequence":"first","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Mantzoros","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0861-8783","authenticated-orcid":false,"given":"Orestis","family":"Ioannidis","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Zapsalis","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5650-7319","authenticated-orcid":false,"given":"Elissavet","family":"Anestiadou","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Styliani","family":"Parpoudi","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8139-3357","authenticated-orcid":false,"given":"Dimitrios","family":"Kyziridis","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekaterini","family":"Klonou","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savvas","family":"Simeonidis","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8281-1189","authenticated-orcid":false,"given":"Stefanos","family":"Bitsianis","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manousos George","family":"Pramateftakis","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efstathios","family":"Kotidis","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stamatios","family":"Angelopoulos","sequence":"additional","affiliation":[{"name":"4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s10029-009-0587-x","article-title":"Hernia repair: The search for ideal meshes","volume":"14","author":"Bringman","year":"2010","journal-title":"Hernia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1007\/s004640020013","article-title":"Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia","volume":"14","author":"DeMaria","year":"2000","journal-title":"Surg. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1007\/s00268-006-0502-x","article-title":"Repair of giant midline abdominal wall hernias: \u201ccomponents separation technique\u201d versus prosthetic repair: Interim analysis of a randomized controlled trial","volume":"31","author":"Charbon","year":"2007","journal-title":"World J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.suc.2007.11.007","article-title":"Surgical progress in inguinal and ventral incisional hernia repair","volume":"88","author":"Gray","year":"2008","journal-title":"Surg. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1007\/BF02234701","article-title":"Postoperative adhesions: Ten-year follow-up of 12,584 patients undergoing lower abdominal surgery","volume":"44","author":"Parker","year":"2001","journal-title":"Dis. Colon. Rectum"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"f5588","DOI":"10.1136\/bmj.f5588","article-title":"Burden of adhesions in abdominal and pelvic surgery: Systematic review and met-analysis","volume":"347","author":"Issa","year":"2013","journal-title":"BMJ"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1002\/bjs.7657","article-title":"Pathogenesis of postoperative adhesion formation","volume":"98","author":"Hellebrekers","year":"2011","journal-title":"Br. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4545","DOI":"10.3748\/wjg.v17.i41.4545","article-title":"Pathophysiology and prevention of postoperative peritoneal adhesions","volume":"17","author":"Arung","year":"2011","journal-title":"World J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10029-012-0913-6","article-title":"Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes","volume":"16","author":"Klinge","year":"2012","journal-title":"Hernia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/S0140-6736(98)09337-4","article-title":"Adhesion-related hospital readmissions after abdominal and pelvic surgery: A retrospective cohort study","volume":"353","author":"Ellis","year":"1999","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s00268-005-7778-0","article-title":"Laparoscopic lysis of adhesions","volume":"30","author":"Szomstein","year":"2006","journal-title":"World J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s00268-006-0317-9","article-title":"Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery","volume":"31","author":"Halm","year":"2007","journal-title":"World J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1007\/s00464-004-2192-5","article-title":"Intraabdominal adhesion formation of polypropylene mesh Influence of coverage of omentum and polyglactin","volume":"19","author":"Conze","year":"2005","journal-title":"Surg. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1002\/bjs.8954","article-title":"Experimental study on synthetic and biological mesh implantation in a contaminated environment","volume":"99","author":"Deerenberg","year":"2012","journal-title":"Br. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1007\/s10439-008-9608-7","article-title":"Polypropylene meshes to prevent abdominal herniation. Can stable coatings prevent adhesions in the long term?","volume":"37","author":"Emans","year":"2009","journal-title":"Ann. Biomed. Eng."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1007\/s00268-013-2019-4","article-title":"Implantation of Prophylactic Nonabsorbable Intraperitoneal Mesh in Patients with Peritonitis Is Safe and Feasible","volume":"37","author":"Kurmann","year":"2013","journal-title":"World J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1002\/bjs.10635","article-title":"Characteristics of different mesh types for abdominal wall repair in an experimental model of peritonitis","volume":"104","author":"Kaufmann","year":"2017","journal-title":"Br. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/SLA.0b013e31822518e6","article-title":"Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: Outcomes of 33,832 cases","volume":"255","author":"Choi","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1001\/archsurg.2010.144","article-title":"Impact of mesh use on morbidity following ventral hernia repair with a simultaneous bowel resection","volume":"145","author":"Xourafas","year":"2010","journal-title":"Arch. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1002\/bjs.6446","article-title":"Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model","volume":"96","author":"Schreinemacher","year":"2009","journal-title":"Br. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/S0022-4804(03)00158-6","article-title":"Assessment of adhesion formation to intra-abdominal polypropylene mesh and polytetrafluoroethylene mesh","volume":"114","author":"Matthews","year":"2003","journal-title":"J. Surg. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1002\/bjs.1800780117","article-title":"Effect of fibrin sealant on the healing colonic anastomosis in the rat","volume":"78","author":"Kort","year":"1991","journal-title":"Br. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1093\/bjs\/znad284","article-title":"Midline incisional hernia guidelines: The European Hernia Society","volume":"110","author":"Sanders","year":"2023","journal-title":"Br. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4202","DOI":"10.1007\/s00464-013-3021-5","article-title":"Coated meshes for hernia repair provide comparable intraperitoneal adhesion prevention","volume":"27","author":"Schreinemacher","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/S0015-0282(98)00270-2","article-title":"The rates of adhesion development and the effects of crystalloid solutions on adhesion development in pelvic surgery","volume":"70","author":"Wiseman","year":"1998","journal-title":"Fertil. Steril."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/00000658-199603000-00003","article-title":"Foreign material in postoperative adhesions","volume":"223","author":"Luijendijk","year":"1996","journal-title":"Ann. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/S0039-6109(16)39595-0","article-title":"The use of prosthetic materials in the repair of hernias","volume":"51","author":"Smith","year":"1971","journal-title":"Surg. Clin. N. Am."},{"key":"ref_28","first-page":"911","article-title":"Formation of Adhesions at Surgical Meshes in a Rat Experimental Mode","volume":"35","author":"Perko","year":"2011","journal-title":"Coll. Antropol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1046\/j.1365-2168.2000.01364.x","article-title":"Intraperitoneal polypropylene mesh repair of incisional hernia is not associated with enterocutaneous fistula","volume":"87","author":"Vrijland","year":"2000","journal-title":"Br. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/SLA.0b013e3181f9b6e6","article-title":"A review of available prosthetics for ventral hernia repair","volume":"253","author":"Shankaran","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jss.2018.03.019","article-title":"Comparability of histological outcomes in rats and humans in a hernia model","volume":"229","author":"Vogels","year":"2018","journal-title":"J. Surg. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1007\/s00464-010-1432-0","article-title":"Physicomechanical evaluation of absorbable and nonabsorbable barrier composite meshes for laparoscopic ventral hernia repair","volume":"25","author":"Deeken","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e2544303","DOI":"10.1001\/jamanetworkopen.2025.44303","article-title":"Long-Term Recurrence and the Safety of Mesh Use After Emergency Ventral Hernia Repair","volume":"8","author":"Isenberg","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Parpoudi, S., Mantzoros, I., Ioannidis, O., Zapsalis, K., Gamali, T., Kyziridis, D., Gekas, C., Anestiadou, E., Symeonidis, S., and Bitsianis, S. (2025). Effect of N-Acetyl-L-Cysteine (NAC) on Inflammation After Intraperitoneal Mesh Placement in an Escherichia coli Septic Rat Model: A Randomized Experimental Study. Med. Sci., 13.","DOI":"10.3390\/medsci13040318"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1016\/j.asjsur.2021.11.001","article-title":"Effect of N-acetyl-L-cysteine on inflammation after intraperitoneal mesh placement in a potentially contaminated environment: An experimental study in the rat","volume":"45","author":"Parpoudi","year":"2022","journal-title":"Asian J. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s10029-013-1124-5","article-title":"An in vitro study assessing the effect of mesh morphology and suture fixation on bacterial adherence","volume":"17","author":"Sanders","year":"2013","journal-title":"Hernia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1051\/bmdcn\/2017070316","article-title":"Mesh materials and hernia repair","volume":"7","author":"Elango","year":"2017","journal-title":"Biomedicine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"121940","DOI":"10.1016\/j.biomaterials.2022.121940","article-title":"Anti-adhesive bioresorbable elastomer-coated composite hernia mesh that reduce intraperitoneal adhesions","volume":"292","author":"Nikam","year":"2023","journal-title":"Biomater. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1007\/s00268-005-0511-1","article-title":"Effect of temporary abdominal closure on colonic anastomosis and postoperative adhesions in experimental secondary peritonitis","volume":"30","author":"Aydin","year":"2006","journal-title":"World J. Surg."},{"key":"ref_40","first-page":"e92557","article-title":"Efficacy of Biological Versus Synthetic Mesh in Ventral Hernia Repair: A Systematic Review and Meta-Analysis of Long-Term Outcomes and Recurrence Rates","volume":"17","author":"Khan","year":"2025","journal-title":"Cureus"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.jss.2023.07.003","article-title":"Mesh type with ventral hernia repair: A systematic review and meta-analysis of randomized trials","volume":"291","author":"Siddiqui","year":"2023","journal-title":"J. Surg. Res."},{"key":"ref_42","first-page":"1001","article-title":"Biologic versus synthetic mesh in open ventral hernia repair: A systematic review and meta-analysis of randomized controlled trials","volume":"173","author":"Tastaldi","year":"2023","journal-title":"J. Surg. Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/803\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T12:42:08Z","timestamp":1776861728000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["medicina62050803"],"URL":"https:\/\/doi.org\/10.3390\/medicina62050803","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]}}}